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The Indian Journal of Radiology &... Jul 2024Although abundant literature is currently available on the use of deep learning for breast cancer detection in mammography, the quality of such literature is widely... (Review)
Review
Although abundant literature is currently available on the use of deep learning for breast cancer detection in mammography, the quality of such literature is widely variable. To evaluate published literature on breast cancer detection in mammography for reproducibility and to ascertain best practices for model design. The PubMed and Scopus databases were searched to identify records that described the use of deep learning to detect lesions or classify images into cancer or noncancer. A modification of Quality Assessment of Diagnostic Accuracy Studies (mQUADAS-2) tool was developed for this review and was applied to the included studies. Results of reported studies (area under curve [AUC] of receiver operator curve [ROC] curve, sensitivity, specificity) were recorded. A total of 12,123 records were screened, of which 107 fit the inclusion criteria. Training and test datasets, key idea behind model architecture, and results were recorded for these studies. Based on mQUADAS-2 assessment, 103 studies had high risk of bias due to nonrepresentative patient selection. Four studies were of adequate quality, of which three trained their own model, and one used a commercial network. Ensemble models were used in two of these. Common strategies used for model training included patch classifiers, image classification networks (ResNet in 67%), and object detection networks (RetinaNet in 67%). The highest reported AUC was 0.927 ± 0.008 on a screening dataset, while it reached 0.945 (0.919-0.968) on an enriched subset. Higher values of AUC (0.955) and specificity (98.5%) were reached when combined radiologist and Artificial Intelligence readings were used than either of them alone. None of the studies provided explainability beyond localization accuracy. None of the studies have studied interaction between AI and radiologist in a real world setting. While deep learning holds much promise in mammography interpretation, evaluation in a reproducible clinical setting and explainable networks are the need of the hour.
PubMed: 38912238
DOI: 10.1055/s-0043-1775737 -
Open Life Sciences 2024Richter transformation (RT) represents the development of intrusive lymphoma in individuals previously or concurrently diagnosed with chronic lymphocytic leukemia (CLL)...
Richter transformation (RT) represents the development of intrusive lymphoma in individuals previously or concurrently diagnosed with chronic lymphocytic leukemia (CLL) and is characterized by lymph node enlargement. However, cases involving extra-nodal organ involvement as the first symptom are rare. There are no reports of RT with breast lesions as the first symptom. Nonspecific and atypical clinical manifestations represent key challenges in the accurate diagnosis and appropriate treatment of RT. This case report describes an elderly female patient who presented with breast lesions as the first RT symptom. The patient was admitted with a painless mass in the left breast. Examination revealed multiple lymphadenopathies and abnormally high white blood cell levels. The patient was diagnosed with CLL after hematological tests, assessments of bone marrow morphology, and tissue biopsy. Mammography and B-ultrasonography showed solid space-occupying lesions (BI-RADS category 5) in the left breast. Initially, the patient declined a breast biopsy and was therefore prescribed ibrupotinib treatment, which showed limited efficacy. A needle biopsy of the affected breast indicated the presence of diffuse large B-cell lymphoma. Based on auxiliary and pathological examinations and medical history, the final diagnosis was RT with breast involvement. Zanubrutinib with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone treatment provided initial control; however, the treatment strategy required adjustment because of the patient's fluctuating condition. The current status of the patient is marked as stable, showing an overall achievement of partial alleviation. The patient is in the process of receiving follow-up treatment. We also performed a comprehensive literature review on RT, with particular emphasis on its biological paradigm, prognosis implications, existing therapeutic approaches, and emerging directions in treatment modalities.
PubMed: 38911930
DOI: 10.1515/biol-2022-0889 -
BMC Women's Health Jun 2024Breast imaging clinics in the United States (U.S.) are increasingly implementing breast cancer risk assessment (BCRA) to align with evolving guideline recommendations...
BACKGROUND
Breast imaging clinics in the United States (U.S.) are increasingly implementing breast cancer risk assessment (BCRA) to align with evolving guideline recommendations but with limited uptake of risk-reduction care. Effectively communicating risk information to women is central to implementation efforts, but remains understudied in the U.S. This study aims to characterize, and identify factors associated with women's interest in and preferences for breast cancer risk communication.
METHODS
This is a cross-sectional survey study of U.S. women presenting for a mammogram between January and March of 2021 at a large, tertiary breast imaging clinic. Survey items assessed women's interest in knowing their risk and preferences for risk communication if considered to be at high risk in hypothetical situations. Multivariable logistic regression modeling assessed factors associated with women's interest in knowing their personal risk and preferences for details around exact risk estimates.
RESULTS
Among 1119 women, 72.7% were interested in knowing their breast cancer risk. If at high risk, 77% preferred to receive their exact risk estimate and preferred verbal (52.9% phone/47% in-person) vs. written (26.5% online/19.5% letter) communications. Adjusted regression analyses found that those with a primary family history of breast cancer were significantly more interested in knowing their risk (OR 1.5, 95% CI 1.0, 2.1, p = 0.04), while those categorized as "more than one race or other" were significantly less interested in knowing their risk (OR 0.4, 95% CI 0.2, 0.9, p = 0.02). Women 60 + years of age were significantly less likely to prefer exact estimates of their risk (OR 0.6, 95% CI 0.5, 0.98, p < 0.01), while women with greater than a high school education were significantly more likely to prefer exact risk estimates (OR 2.5, 95% CI 1.5, 4.2, p < 0.001).
CONCLUSION
U.S. women in this study expressed strong interest in knowing their risk and preferred to receive exact risk estimates verbally if found to be at high risk. Sociodemographic and family history influenced women's interest and preferences for risk communication. Breast imaging centers implementing risk assessment should consider strategies tailored to women's preferences to increase interest in risk estimates and improve risk communication.
Topics: Humans; Female; Breast Neoplasms; Cross-Sectional Studies; Middle Aged; Patient Preference; United States; Adult; Mammography; Risk Assessment; Aged; Communication; Surveys and Questionnaires; Tertiary Care Centers; Health Knowledge, Attitudes, Practice
PubMed: 38907193
DOI: 10.1186/s12905-024-03197-7 -
European Radiology Jun 2024
Iodine-based contrast media in contrast-enhanced mammography and dedicated breast computed tomography: is it necessary to assess renal function in all outpatients to prevent contrast-induced acute kidney injury?
PubMed: 38907100
DOI: 10.1007/s00330-024-10871-9 -
RoFo : Fortschritte Auf Dem Gebiete Der... Jun 2024Axillary lymphadenopathy (LA) after COVID-19 vaccination is now known to be a common side effect. In these cases, malignancy cannot always be excluded on the basis of...
Axillary lymphadenopathy (LA) after COVID-19 vaccination is now known to be a common side effect. In these cases, malignancy cannot always be excluded on the basis of morphological imaging criteria.Narrative review for decision-making regarding control and follow-up intervals for axillary LA according to currently published research. This article provides a practical overview of the management of vaccine-associated LA using image examples and a flowchart and provides recommendations for follow-up intervals. A particular focus is on patients presenting for diagnostic breast imaging. The diagnostic criteria for pathological lymph nodes (LN) are explained.Axillary LA is a common adverse effect after COVID-19 vaccination (0.3-53%). The average duration of LA is more than 100 days. LA is also known to occur after other vaccinations, such as the seasonal influenza vaccine. Systematic studies on this topic are missing. Other causes of LA after vaccination (infections, autoimmune diseases, malignancies) should be considered for the differential diagnosis. If the LA persists for more than 3 months after COVID-19 vaccination, a primarily sonographic follow-up examination is recommended after another 3 months. A minimally invasive biopsy of the LA is recommended if a clinically suspicious LN persists or progresses. In the case of histologically confirmed breast cancer, a core biopsy without a follow-up interval is recommended regardless of the vaccination, as treatment appropriate to the stage should not be influenced by follow-up intervals. For follow-up after breast cancer, the procedure depends on the duration of the LA and the woman's individual risk of recurrence.Vaccination history should be well documented and taken into account when evaluating suspicious LN. Biopsy of abnormal, persistent, or progressive LNs is recommended. Preoperative staging of breast cancer should not be delayed by follow-up. The risk of false-positive findings is accepted, and the suspicious LNs are histologically examined in a minimally invasive procedure. · The vaccination history must be documented (vaccine, date, place of application).. · If axillary LA persists for more than 3 months after vaccination, a sonographic follow-up examination is recommended after 3 months.. · Enlarged LNs that are persistent, progressive in size, or are suspicious on control sonography should be biopsied.. · Suspicious LNs should be clarified before starting oncological therapy, irrespective of the vaccination status, according to the guidelines and without delaying therapy.. · Wilpert C, Wenkel E, Baltzer PA et al. Vaccine-associated axillary lymphadenopathy with a focus on COVID-19 vaccines. Fortschr Röntgenstr 2024; DOI 10.1055/a-2328-7536.
PubMed: 38906159
DOI: 10.1055/a-2328-7536 -
Radiological Physics and Technology Jun 2024Diagnostic reference level (DRL) for mammography for 2015 and 2020 has been published by J-RIME. More new dose studies are needed to revise the next DRL. In preparation...
Diagnostic reference level (DRL) for mammography for 2015 and 2020 has been published by J-RIME. More new dose studies are needed to revise the next DRL. In preparation for the next revision of the DRL for mammography, this study investigated data from the Japan Central Organization on Quality Assurance of Breast Cancer Screening on the mean average glandular dose (AGD) for institutional image accreditation in 2019-2023 and the relationship between the average at eligible institutions to date and the type of breast X-ray system. The 95th percentile values of the AGD distributions for the Computed Radiography (CR) and Flat Panel Detector (FPD) systems were 2.5 mGy and 2.0 mGy, respectively. Moreover, it is assumed that AGD is decreasing due to the spread of FPD systems, and it is expected that the further spread of FPD systems and systems with W/Rh target/filter will reduce AGD in future.
PubMed: 38904916
DOI: 10.1007/s12194-024-00823-9 -
Cureus May 2024Breast cancer represents a significant global health challenge, with Saudi Arabia experiencing high incidence rates, particularly among females. Early detection...
BACKGROUND
Breast cancer represents a significant global health challenge, with Saudi Arabia experiencing high incidence rates, particularly among females. Early detection through screening methods such as mammography and breast self-examination offers promise in reducing mortality rates. However, participation in screening remains suboptimal, posing a barrier to effective cancer control. In regions like Jazan, situated in southwestern Saudi Arabia, comprehensive studies on breast cancer awareness and screening practices are lacking.
METHODS
This cross-sectional study conducted in Jazan, Saudi Arabia, aimed to comprehensively assess breast cancer awareness, perceptions, and screening practices among the local population. An online survey platform was utilized to reach individuals aged 18 years or older residing in Jazan. Recruitment efforts utilized social media platforms, community networks, and local organizations to ensure diverse representation across socioeconomic backgrounds, education levels, and geographical locations. A meticulously designed questionnaire captured demographic information, breast cancer awareness, knowledge, health-seeking behaviors, screening practices, and barriers to mammogram screening. Participants provided electronic informed consent before self-administering the questionnaire.
RESULTS
The study conducted in Jazan, Saudi Arabia, encompassed 533 participants, predominantly young to middle-aged individuals. Most participants were Saudi nationals (97.6%), employed in the government sector (55.7%), and resided in urban areas (61.0%). Awareness of breast cancer was high, with 98.1% having heard of the disease. However, perceptions of age of onset and prevalence varied. While participants showed varied awareness of breast cancer warning signs and risk factors, family history was a commonly agreed-upon risk factor (54.4%). Health-seeking behavior for breast cancer symptoms varied, with nipple changes prompting the most immediate medical attention (36.4%). Although most participants were aware of self-breast examination (84.6%) and mammograms (56.7%), utilization rates were suboptimal, with barriers including fear (79.7%) and embarrassment (71.5%) hindering mammogram screening uptake.
CONCLUSION
This study provides insights into breast cancer awareness and screening practices among participants in Saudi Arabia. While awareness of breast self-examination and mammography is high, disparities in screening service access persist due to barriers like fear and embarrassment. Addressing these barriers through culturally sensitive interventions and collaborative efforts is crucial for enhancing screening uptake and promoting health equity.
PubMed: 38903297
DOI: 10.7759/cureus.60759 -
Preventive Medicine Jun 2024To investigate the relationship between Body Mass Index (BMI) and adherence to recommended screening tests, addressing gaps in previous literature by utilizing a large...
OBJECTIVE
To investigate the relationship between Body Mass Index (BMI) and adherence to recommended screening tests, addressing gaps in previous literature by utilizing a large cohort, while considering longitudinal changes in weight and the type of screening.
METHODS
Data from Clalit Health Services in Israel were retrospectively analyzed, including participants aged 50 and above from 2002 to 2021. BMI measurements and various screening test records were examined. Generalized Estimating Equations were employed for analysis, adjusting for potential confounding variables, including age, gender, geographic location, and socioeconomic status.
RESULTS
The study included 634,879 participants with 4,630,030 BMI measurements and 56,453,659 test records. Participants were categorized into BMI cohorts at the time of the test, with overweight and obese individuals showing lower odds of undergoing intimate examination-based screening tests (mammography, PAPS, and skin examination), as opposed to higher odds of several non-intimate tests (e.g., diabetes and eye disorder screenings).
DISCUSSION
Our findings suggest that individuals with overweight and obesity are less likely to undergo screenings involving intimate physical examinations, potentially due to weight stigma and discomfort. This avoidance behavior may contribute to increased morbidity rates in these populations. Interventions addressing weight stigma, improving access to care, and enhancing patient engagement are warranted.
PubMed: 38901741
DOI: 10.1016/j.ypmed.2024.108045 -
JCO Oncology Practice Jun 2024Black and White women undergo screening mammography at similar rates, but racial disparities in breast cancer outcomes persist. To assess potential contributors, we...
PURPOSE
Black and White women undergo screening mammography at similar rates, but racial disparities in breast cancer outcomes persist. To assess potential contributors, we investigated delays in follow-up after abnormal imaging by race/ethnicity.
METHODS
Women who underwent screening mammography at our urban academic center from January 2015 to February 2018 and received a Breast Imaging Reporting and Data System 0 assessment were included. Kaplan-Meier estimates described distributions of time between diagnostic events from (1) screening to diagnostic imaging and (2) diagnostic imaging to biopsy. Multivariable logistic regression models estimated the associations between race/ethnicity and receipt of follow-up within 15 and 30 days.
RESULTS
Two thousand five hundred and fifty-four women were included (48.6% non-Hispanic [NH] Black, 38.2% NH White, 13.1% other/unknown). Median time between screening and diagnostic imaging varied by race/ethnicity (White: 7 days [IQR, 2-14]; Black: 12 days [IQR, 7-23]; other/unknown: 9 days [IQR, 5-21]). There were similar disparities in days between diagnostic imaging and biopsy (White: 12 [IQR, 7-24]; Black: 21 [IQR, 13-37]; other/unknown: 16 [IQR, 9-30]) and between screening and biopsy (White: 20 [IQR, 11-41]; Black: 35 [IQR, 22-63]; other/unknown: 27.5 [IQR, 17-42]). After adjustment, odds of diagnostic imaging follow-up within 15 days of screening were lower for Black versus White women (odds ratio, 0.59 [95% CI, 0.44 to 0.80]; < .001).
CONCLUSION
In this diverse cohort, disparities in timely diagnostic follow-up after abnormal breast screening were observed, with Black women waiting 1.75 times as long as White women to obtain a tissue diagnosis. National guidelines for time to diagnostic follow-up may facilitate more timely breast cancer care and potentially affect outcomes.
PubMed: 38900977
DOI: 10.1200/OP.23.00782 -
Breast Cancer Research and Treatment Jun 2024To assess the reliability of excising residual breast cancer lesions after neoadjuvant systemic therapy (NAST) using a previously localized paramagnetic seed (Magseed®)...
Reliability of Magseed® marking before neoadjuvant systemic therapy with subsequent contrast-enhanced mammography in patients with non-palpable breast cancer lesions after treatment: the MAGMA study.
PURPOSE
To assess the reliability of excising residual breast cancer lesions after neoadjuvant systemic therapy (NAST) using a previously localized paramagnetic seed (Magseed®) and the subsequent use of contrast-enhanced spectral mammography (CESM) to evaluate response.
METHODS
Observational, prospective, multicenter study including adult women (> 18 years) with invasive breast carcinoma undergoing NAST between January 2022 and February 2023 with non-palpable tumor lesions at surgery. Radiologists marked tumors with Magseed® during biopsy before NAST, and surgeons excised tumors guided by the Sentimag® magnetometer. CESMs were performed before and after NAST to evaluate tumor response (Response Evaluation Criteria for Solid Tumors [RECIST]). We considered intraoperative, surgical, and CESM-related variables and histological response.
RESULTS
We analyzed 109 patients (median [IQR] age of 55.0 [46.0, 65.0] years). Magseed® was retrieved from breast tumors in all surgeries (100%; 95% CI 95.47-100.0%) with no displacement and was identified by radiology in 106 patients (97.24%), a median (IQR) of 176.5 (150.0, 216.3) days after marking. Most surgeries (94.49%) were conservative; they lasted a median (IQR) of 22.5 (14.75, 40.0) min (95% CI 23.59-30.11 min). Most dissected tumor margins (93.57%) were negative, and few patients (5.51%) needed reintervention. Magseed® was identified using CESM in all patients (100%); RECIST responses correlated with histopathological evaluations of dissected tumors using the Miller-Payne response grade (p < 0.0001) and residual lesion diameter (p < 0.0001). Also 69 patients (63.3%) answered a patient's satisfaction survey and 98.8% of them felt very satisfied with the entire procedure.
CONCLUSION
Long-term marking of breast cancer lesions with Magseed® is a reliable and feasible method in patients undergoing NAST and may be used with subsequent CESM.
PubMed: 38898360
DOI: 10.1007/s10549-024-07407-6